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Clinical Decision Making in Melanoma: What Is Best Practice? 

  • Authors: Caroline Robert, MD, PhD
  • CME / ABIM MOC Released: 2/8/2021
  • Valid for credit through: 2/8/2022, 11:59 PM EST
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Target Audience and Goal Statement

This activity is intended for hematology/oncology specialists, dermatologists, and pathologists.

The goal of this activity is to improve competence of physicians in the diagnosis and management of patients with melanoma who would benefit from treatment with immune checkpoint inhibitors (ICIs) both in the adjuvant and in the metastatic setting.

Upon completion of this activity, participants will:

  • Have increased knowledge regarding the
    • Use of biomarker testing in patients with melanoma to help guide treatment selection
  • Have greater competence related to
    • Identifying appropriate use of ICIs in patients with stage III or metastatic melanoma
  • Demonstrate greater confidence in their ability to
    • Identify immune-related adverse events in patients with melanoma both during and after treatment with an ICI


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  • Caroline Robert, MD, PhD

    Head of the Dermatology Unit
    Gustave Roussy Cancer Center
    Villejuif, France


    Disclosure: Caroline Robert, MD, PhD, has disclosed the following relevant financial relationships:
    Served as an advisor or consultant for: Amgen; Biothera; CureVac; Bristol Myers Squibb; Merck Sharpe & Dohme; Novartis; Pierre Fabre; Roche; Sanofi


  • Charlotte Warren

    Senior Medical Education Director, Medscape, LLC


    Disclosure: Charlotte Warren has disclosed no relevant financial relationships.

  • Tristin Abair, PhD

    Senior Medical Writer, Medscape, LLC


    Disclosure: Tristin Abair, PhD, has disclosed no relevant financial relationships.

CME Reviewer

  • Stephanie Corder, ND, RN, CHCP

    Associate Director, Accreditation and Compliance, Medscape, LLC


    Disclosure: Stephanie Corder, ND, RN, CHCP, has disclosed no relevant financial relationships.

Medscape, LLC staff have disclosed that they have no relevant financial relationships.

Peer Reviewer

This activity has been peer reviewed and the reviewer has disclosed no relevant financial relationships.

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Clinical Decision Making in Melanoma: What Is Best Practice? 

Authors: Caroline Robert, MD, PhDFaculty and Disclosures

CME / ABIM MOC Released: 2/8/2021

Valid for credit through: 2/8/2022, 11:59 PM EST


The following cases are modeled on the interactive grand rounds approach. The questions within the activity are designed to test your current knowledge. After each question, you will be able to see whether you answered correctly and read evidence-based information that supports the most appropriate answer choice. The questions are designed to challenge you; you will not be penalized for answering the questions incorrectly. At the end of the activity, there will be a short post-test assessment based on the material presented.


Charles is a 55-year-old married football coach who initially presented with a pigmented skin lesion on his right forearm. Biopsy showed an ulcerated, 3.5-mm thick nodular melanoma, which was removed via wide excision with 2.5-cm negative surgical margins. A sentinel lymph node biopsy (SLNB) performed at the time of surgery showed no metastatic disease in the 2 sentinel nodes examined.

Charles is monitored every 6 months and now, 3 years after his initial diagnosis, has a palpable axillary node under his right arm. He undergoes a complete evaluation and is otherwise healthy, with no significant comorbidities. Charles's initial workup is summarized in Table 1. Chest/abdominal/pelvic computed tomography (CT) with contrast and brain magnetic resonance imaging (MRI) with contrast are both negative for metastatic disease. A complete axillary dissection is performed, which identifies 1 positive lymph node out of 14 total nodes examined. The positive node has 10 mm of melanoma involvement.

Table 1. Summary of Charles's Initial Workup

  • 55 years old, male
  • Height: 1.8 meters; Weight: 75 kg; BMI: 23.1
Personal and family medical history
  • Nonsmoker; no significant comorbidities
  • No prior surgeries
  • Current medications include only supplemental vitamins
  • No family history of cancer
Physical exam
  • Heart rate 70 bpm, BP 115/82
  • 1 palpable node in right axilla, no skin changes in area of initial lesion on forearm
  • ECOG PS 0
Imaging and nodal evaluation
  • CT with contrast: negative for systemic metastases
  • Contrast-enhanced brain MRI: negative
  • Completion axillary dissection: 1 of 14 nodes positive for metastatic disease (10 mm tumor involvement)
BMI = body mass index; BP = blood pressure; ECOG = Eastern Cooperative Oncology Group; PS = performance status.

Since molecular testing was not performed on the initial primary tumor, you order biomarker testing of the positive lymph node.

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